the town square is a part of that. we have to move on. >> is the square a day treatment model, a step down? >> no, it's not. just one thing and i will answer that. my suggestion is i will have to come back and talk to you at a different time which i suggest that you not be so focused on skilled nursing. the issues are not going to be addressed in those beds. they are going to be addressed in changes and how assisted living is going to be in the future. i appreciate your focus on the concern on the shortage of beds. there is a much broader response to that. no, by the way, i'm involved in doing #2re7bding accrue -- trending across the country. it's not a day hospital

model at all. it's a model in practice through us being developed and we are going to do on a membership, there will be some third party payment. so it's not a medical model hospital model approach, quite the contrary. we are taking it from a much more humanistic social services holistic approach. >> it sounds to me like coordinated care. the city, we don't have enough geriatric specialist to under the aging population and the different kinds of needs they have. it's great that you have coordinated care and assigned case managers to help. it sounds like a very promising model and we look forward to hearing what the results. >> another example of us

developing a bunch of models for people. we have a bunch to do. >> we are going to attack this again on december 2nd. >> i hope attack is a good word. >> item 8 is resolution from laguna honda transportation agreement to require two medium sized transit shuttle vehicles. >> good afternoon. i will be quick. i'm here to gain your approval for a resolution to enter into a state agreement for two medium sized vehicles to be used as shuttles for our community laguna honda hospital. there is under resolve, it

should say $134,000. so $67,000 each for a vehicle times two and i'm here to gain your approval. >> this is grants money so it's not out of our operational budget. i think we are probably in favor of people giving of vehicles that are operable. do we have to vote for this? is there any public comment? >> no public comment. >> is there a motion? >> i move. >> second. >> all in favor say, "aye". >> aye. >> any opposed? >> congratulations. thank you commissioners, the next item on the genetic is the san francisco health network quarterly

update. >> good evening, commissioners. and with your permission given the lateness of the hour, i will make my comments brief and ask that my colleagues also have brevity of their presentations to you if that's okay. again, good evening, it's my pleasure to return and give you an update on the project. i'm roland, the director of the health network. as i came to you in march, i have a lot of progress in this area.

and we have those who have helped in meeting those initiatives. what we have planned today is we have key areas highlighted and accomplished thus far. i plan to give a brief review of the ordinance and perhaps we may skip that and we want to go into our way forward measures to outline our road map for success to the network and health care reform on dpa and opportunity to take your questions, comments and suggestions. okay. in terms of the highlights and accomplishments, there are three significant ones that i want to share. first we developed a business and intelligence unit. that unit provides

infrastructure and data support and intelligence to provide consistency across the network. second is we have a new ambulatory care across the network that included the appointment of a primary care director whom you will hear from shortly and that role is to solidify the role as a primary point of entry for care coordination and finally we have a new managed care office which included the appointment of a managed care director whose sole job is to singular focus medicare management to relationships and concept strategies and we also initiated tracking of patient rolement capacity and access.

as i mentioned i was going through genesis of the network, but a brief overview. the network was formed as a result of the assessment of 2012 and 2013. as you know, those two initiatives led to the birth of our network. and when i came to you in march we thought we were in our infancy. we are now in our two hands and niece and -- knees and beginning to crawl. i mentioned the top priority areas that mentioned the health plus delivery system and task

ready. we decided we would focus on these 10-12 initiatives over our first 18 -month period which will take us through june 2015. back in march, all 12 were in their initial stage of development as noted by the yellow color. i'm happy to report that as of today 5 of the 12 priorities are completed and the rest are under way on a path to completion. now it's my pleasure to provide you the co-lead of the intelligence unit and san francisco hospital administrator to share with you some of the great work by the intelligence unit.

>> good evening, commissioners and colleagues. the basis is the goals that have been reinforced anatomy -- in a variety of venues. the speakers that will follow me in this presentation data core to mention our progress we have those dedicated to this data. that's the focus to provide that same support to this over arching goal that we have and ultimately you have the appendix which you have just read and provide support which is credible data that can be returned the information to the allocation and the over

arching is the idea to partner with experts, have education training to turn that data into information, disseminate it to have access to it and seeing what it says, it's descriptive analytics and we want to turn it to diagnostics analytics and the process. once you see something you might want to tailor the report and how we read the data and how we discuss it. what are we doing with that data? what are the actual changes to the place. that's the rest of the take away and the rest you will hear about sharing the data and our progress and i want to turn it over to our lead now. >> good evening, commissioners, my name is kim noun.

he mentioned our road map for success. these will measure the progress of our health network and we'll go in more detail. it is in the back of your documentation. in addition to measuring the health network, this also ties into health reform goals. you will see outlined on the right, our first outline goals is access for a reasonable time and this is the way for metrics of 123, 9 and 10. the second goal is capitation, which is one rate of payment per month and this ties into our managed care dashboard that was for a few meetings ago and the third goal is for being the provider of choice.

moving from last resort to being the provider or the attractive choice and this ties for a metric of 4567 and 8. and as mentioned the way for dashboard is in your documentation. i will go very quickly for how to read it. this is our road map to success and the intent is to measure our progress. you will see that the performance metrics are on the left hand side. it is outlined from numbers 1-10. as you move along you will see the frequency in reporting, that could be quarter, semi annually or annually and you have the baseline date which is where we are starting from and what we are going against and you have the target that we set for the dashboard and then moving forward we have our prior period average which

compares to our first period average and the percent of change and whether it's a positive or negative outcome and the core on the right hand side are trends and you will see it build upon as we are having more data. so, here just a few snapshots of some of our highlights we have metric 3 which is a 5.1 percent increase at the appropriate setting of level of care. then of course another highlight is metric 10 increased by 25 percent, the number of clients and there was a 23 percent positive outcome change. i would like to now hand it over to dr. albert yu, san francisco director of ambulatory care. >> good evening commissioners, my name

is -- albert yu. i'm here to talk about ambulatory care. before i start, this is a different slide. before i start i'm going to introduce dr. dolly hammer, the primary care director who has played an incredible role to lead the activities of the primary care team to make sure we can actually improve access and grow capacity in terms of enrollment and drive experience. the document you received is a little bit lengthy. i apologize. the first few pages gives you an organizational structure of the ambulatory care highlanding each section and what it offers. the remaining document provides the efforts aiding in health

readiness recommendation. the other one is not documenting the performances of ambulatory care outcome finance or quality but i did include a slide in the back to give you an overview of quality measures compared to national bench marks. i'm going to address four areas in terms of primary care which we have been charged to do. the first goal is to action on issues. this dashboard is probably the single most important intervention of measures in place over the last month or so to the leadership team to drive improvement as well as forcing them to ask the question, what can we do as a team to improve the access in the next week so it's not done in the

next month or next quarter. that has demonstrated a tremendous improvement at each care site. we are also implementing a telephone provider appointment so our nurse, in vice line when they feel they need to address needs at that moment they can quickly translate that over to reduce the demand on the clinics and addressing the patients needs. the second is no wait list. these slides are a little bit different. the second one is no wait. as you can see from that handout from a year 1/2 ago, we were at 450 days as to bringing a new patient into our system. over the last 18 months we have brought it to zero same

day for new patients some where between 5-7 days. much of that effort has mostly due to new patient appointment unit as well as our orientation unit. we focus a lot of effort in the first half of this year in anticipation of growth enrollment to detain the new enrollees to provide the number when they call. the first primary care is phone access. that one we haven't fully materialized yet. patients are very frustrated about telephone access. we are working really hard to coordinating a call center. we are working very hard through the higher processing, the hr

system through it and appointment scheduling system to standardize our appointments to book the appointments when patients call. to give you context, over the last three decades we have, in terms of the standardized care. over the 2 -3 decades we have 40 pages of appointment types. that's when each clinic they brought in a new provider we have allowed it to go into a new appointment type that is by very few individuals and that makes it very hard in creating dashboard to profile in comparison of apples to apples. we try to use the core center and research scheduling solution to use that opportunity to standardize our clinic templates.

the fourth area is timing for established patients. that is still an area where we have lots of opportunity to improve. we have greatly improved on patient access. but in terms of return patients that need a return appointment, commonly used metrics in the industry, we still have opportunity to work on that and that will spend the next six months tackling that sort of access points for new enrollees. the fifth area is the systems capacity to view our enrollees to maximize the payment. as you can see, the trend is going up absolutely and we set a target for the measure of 1350 the help of

hma consultant. we started this year with 11,000 enrollees and we are up to 22 and we hope to hit that target by the next year in terms of the goals. much of that is due to lots of capacity adding new capacity and providers and growing our support staff. then i won't talk too much but there is a few other priorities in primary care that certainly can talk more in the future. we are working hard to optimize the patient experience and off cycle time for patients in terms of capacity as well as experience and we are trying to understand that it will cause the patient disenrollment now that we are getting data and why are they leaving us and trying to understand that so we can improve factors that will retain them once they enroll as well as trying

to enhance our provider retention as commissioner, that's one of the hard parts in the competitive market really hard to recruit physicians and retention is important to make sure we retain capacity. now i'm going to introduce you the officer at dph. >> good evening, commissioners, and director garcia. so, i'm not going over the background materials because you have a lot of them but suffice it to say if a needs assessment, in referral or dashboards if you have questions. what is meant about this slide? we have made improvement, we are not where we need to be. we have come across some barriers, they are not insurmountable.

the icon is to remind us that we provide specialty services through a network along with collaboration with csu school of medicine as we need to keep that in mind when we are referring to patients. we are not alone as you look at problems across national head lines. we are much much much better off when i came here . implementation referrals we have cut them in half and we are trying to widdle away at them. the department of managed health care in california has mandated a 15 day wait time for specialty care for any patient. to be honest it's probably 30 days. this is our current state. the top

bucket are surgical clinics. the bottom half are medical clinics. the red bars are 2013 and you can see the progress a year later. if you look at a 60 day period we are doing pretty well. what you don't know, the service is bumped up over the years. for 30 days which is what we are really striving for, you can see the medical specialty is is doing much better and it's the surgical clinic. there are few orthopedic surgeons in san francisco willing to take medicare patients. some are barriers to liability and albert mentioned the hundred

clinic code. >> there are some clinical space. some of those services will have incremental and when we get to our goal we'll do some rational planning to the new hospital. with that, i would like to invite my

colleagues sue curren and the add sfrar -- administrator of laguna honda. >> good evening, we are going to talk to you about our hospitals and implementing health reform and integration with the department. so san francisco general has been busy planning the new hospital. they found time for the two executive committees to meet on a quarterly basis since last year and we are here telling you what we have been doing. first switchboard and telephone operators as of july this year they are housed at san francisco general and in rirn they -- return they are able to answer phone calls regarding lag una honda and sue is going to talk

about the rest. >> so on food and nutrition services we have really got n our leadership together to share best practices and knowledge and also to share some of the tools they use to plan diets and that sort of thing and it's been fairly successful because at san francisco general we did have some issues in our food services area and sent over many of her staff to get to some of the regulatory requirements and that's part of the partnership in working together. as far as pharmacy goes it's integrated long before we had a network. our pharmacy has been under one administrative structure. some of the outcomes that have resulted from that integration have been a n single rational

department from planning around. we have problems with how sales reps from pharmaceutical companies are entering our system and with regard to policies and procedures and regulatory standards together. so pharmacy has kind of led the way. under social services and utilization management mainly under social services what we have been doing here is we are looking for consistency and performance standards for our social workers and really improving the patient flow between san francisco general and laguna honored back -- honda, back and forth. those are some of the highlights that we've been able to accomplish. i'm going to call kelly to talk

about transition. >> thank you, commissioners. thank you commissioners and dr. garcia. we are responsible for ensuring the patient flow to the most

restrictive level of care. programs that were within the san francisco health network to impact this flow were brought together under the oversight of this newly created division. the transition division flow for utilization management for all levels of care. it was created to provide necessary care for the entry and service points throughout san francisco health network to contribute to recovery and wellness. we went from least restrictive to most restrictive to permanent housing and kind of everything in between. that's just our division in a nutshell and i will turn it to stella chow who is in our managed care office. >> thank you. good evening, commissioners.

i would like to share with you our accomplishment in the office of management care. we implemented as mentioned we implemented the office of managed care and have successfully hired, thank you, that was not in the agenda, pushing the button. we have successfully hired two key management positions. let me introduce diana give era, who is the associate of administrator for office of managed care and patient finance and managed care. since may we have standardized the management care membership reporting which allow the managed care to look at the managed care membership number for our network